Medical House Calls Reach Clients in Crisis; Offer Access to Care

Dale Sanderson

The concept of medical house calls seems old-fashioned in these days of overflowing emergency rooms. But to Sound Mental Health (SMH) Physician Assistant Dale Sanderson, house calls to the intellectually disabled are a lifesaver, helping stabilize them to minimize the need for emergency services and hospitalization. He has been part of SMH’s Crisis Stabilization Team (CST) since 2001, helping those with developmental disabilities such as autism, cerebral palsy, and Down syndrome.

Sanderson loves what he does because every day is a “fascinating discovery” where he learns new things about his patients.

“Not being able to speak for yourself doesn’t mean you don’t have something to say,” he says about the clients he serves. “My job is to figure out what they are trying to say. The problem could be environmental, medical, psychiatric, or even an expression of an underlying genetic condition. I act as a detective, putting the puzzle pieces together to improve their lives.”

Sometimes, according to him, challenging behavior can be triggered by a new housemate, changes in medication, pain, food, or lack of sleep. By doing a house call, Sanderson can help answer the question, ‘What is the environment like?’”

He explains that most patients live in supported group settings while some live with family– or are even homeless. Bringing individuals who are agitated into a clinic setting can add to their already significant behavioral challenges. Not uncommonly, individuals are isolated in their home settings and have resisted coming into a clinic, either for medical or psychiatric care.

“These people often are already on a lot of medications,” he points out. Part of his job is to look for side effects and drug-drug interactions that may be contributing to the concerning behavior.

“Sometimes the solution is simple,” he explains. “For example, individuals with developmental disabilities often have stomach problems and may act out after they eat but can’t say they are in pain. Whatever the problem is, we try to make sense of what’s going on and communicate with primary care providers when necessary.” For certain issues, starting psychiatric medications or adjusting doses are a necessary part of providing relief.

Sanderson typically has over 300 interactions with clients every year, plus phone calls and emails. Even with that caseload, he hopes the program could expand.

“SMH’s CST is a remarkable and successful model for treatment,” he says. “The team has proven their existence is essential — as seen in the improvement in the quality of our clients’ lives and success in preventing unnecessary hospitalizations.”

SMH also is filling a void in a state that has a shortage of psychiatric beds and where the State Supreme Court and a federal judge ruled that it is illegal for Washington State to warehouse mentally ill patients in emergency rooms, jails, and regular hospitals. Funding is always in jeopardy, whether the sources of funds are state or federal. This program plays a role in bridging that gap.

To Sanderson, the work is doubly rewarding, in part because he addresses a key issue in the community and because he’s helping people.

“I love my job,” he says of his 20 years in the field. “I have the privilege of helping restore a quality of life to vulnerable people. I am thankful each day.”